Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a common cause of hospitalization, leading to rises in mortality and morbidity in low- and middle-income countries (LMICs), including Bangladesh. Therapeutic benefits have been seen in acute Asthma patients nebulized with magnesium sulfate. So the aim of this study was to investigate the role of nebulized magnesium sulfate as an adjuvant treatment in AECOPD. Objectives: To evaluate the role of nebulized magnesium sulfate in the management of AECOPD. Methods: It was a randomized controlled trial where 324 subjects were enrolled and allocated into two groups with 162 in each group. Then each group received either 2.5 mg salbutamol mixed with 2.5 ml magnesium sulfate or 2.5 mg salbutamol mixed with 2.5 ml isotonic normal saline on three occasions at 30-minute intervals via nebulizer. The role of magnesium sulfate was investigated by measuring PEFR (Peak Expiratory Flow Rate) as the primary outcome parameter at 30, 60, and 90 minutes after nebulization. The secondary outcome measure was to assess Intensive Care Unit (ICU) admission for ventilator support, mortality, changes in respiratory rate and oxygen saturation. Results: The mean PEFR in the magnesium sulfate group at 30, 60 and 90 minutes were 91.36±16.66, 129.44±33.13 and 163.78 ±66.30. Also mean PEFR in normal saline group at 30, 60 and 90 minutes were 72.16±16.66, 85.49±24.80 and 97.81±33.66. PEFR was higher in the magnesium group than in the normal saline group (p < 0.001), which was statistically significant. A total of 15.4% of patients were admitted to the ICU, and 4.9% died among patients nebulized with magnesium sulfate. But 27.2% were admitted to the ICU and 13% died among patients nebulized with normal saline. The p-value was <0.0146, which was statistically significant. Conclusions: Nebulized magnesium as an adjuvant to bronchodilators in the setting of AECOPD resulted in significant improvement of PEFR. J MEDICINE 2026; 27: 62-66
Objective: To assess the pattern of chest x-ray abnormalities and their relationships with disease activity in systemic lupus erythematosus (SLE) patients with cough. Methods: This cross-sectional study was conducted at Bangladesh Medical University’s Department of Rheumatology, Dhaka, Bangladesh. Patients with SLE who reported cough of any duration were enrolled using the 2019 American College of Rheumatology/ European League Against Rheumatism classification criteria. Clinical history, physical examination findings, chest x-ray, relevant lab tests and the SELENASLEDAI score were documented. Subjects were divided into groups based on the presence of chest x-ray abnormality. Multiple logistic regression (backward elimination) was used to identify the factors associated with chest x-ray abnormalities. Results: Eighty cases (74 females and 6 males) with a mean age of 29.2 were recruited. Forty patients had abnormalities in their chest X-rays. Common X-ray abnormalities were cardiomegaly (35%), pleural effusion (27.5%), consolidation (15%), inhomogeneous opacities (22%), reticulonodular shadows (17.5%), pulmonary cavitary lesion (5%) and miliary mottling (2.5%). Shortness of breath, abnormal breath sounds and added sounds were also more marked in these patients. In contrast, those with normal X-ray chest (n=40) had signs and symptoms of upper respiratory tract inflammations only. X-ray abnormalities were associated with low body mass index, increased anti-double-stranded DNA, erythrocyte sedimentation rate, Creactive protein, low hemoglobin and lymphopenia (all P <0.05). X-ray abnormalities were independently associated with a high disease activity score and a high erythrocyte sedimentation rate. Conclusions: Conventional chest x-ray abnormalities were associated with higher disease activity among patients with SLE presenting with cough. J MEDICINE 2026; 27: 78-85
Background: Tenofovir disoproxil fumarate (TDF) is widely used in first-line antiretroviral therapy (ART) and is effective against HIV and hepatitis B, but its long-term impact on renal function is a concern. We aimed to compare renal function in HIV-positive Bangladeshi adults on TDF-containing versus non-TDF ART regimens. Methods: This cross-sectional study was conducted at the ART Center of Bangladesh Medical University(BMU), Dhaka. We recruited 100 HIV-infected adults (age ≥18) on ART for ≥6 months, excluding those with diabetes, hypertension, chronic kidney disease, or Non-Steroidal Anti-Inflammatory Drug (NSAID) use. Seventy patients were on TDF-containing regimens and 30 on non-TDF regimens. Serum creatinine was measured, and estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) formula. Baseline creatinine/eGFR (at ART initiation) were obtained from records. Renal function between groups and changes from baseline within groups were analyzed using t-tests.Results: The participants’ mean age was 36.7 years; 74% were male. After a mean of 23 months on ART, there was no significant difference in mean eGFR between the TDF and non-TDF groups (101.2 ± 27 vs 103.3 ± 28 mL/min/1.73m², p = 0.73). Only 2 patients (both in the TDF group) had eGFR <60. Within the TDF group, eGFR declined from a baseline mean of 107.9 to 101.2 (p = 0.036), with a corresponding rise in serum creatinine (0.83 to 0.90 mg/dL, p = 0.002). No significant change in renal function from baseline was observed in the non-TDF group.Conclusions: Long-term TDF therapy was not associated with significantly worse renal function compared to non-TDF regimens in this cohort, although a mild decline in eGFR was noted in TDF-treated patients. Regular monitoring of renal function is advisable for patients on TDF. Larger longitudinal studies are recommended to confirm the long-term renal safety of TDF. J MEDICINE 2026; 27(2): 94-101
Background: Tuberculous pleural effusion (TPE) is one of the most common types of extrapulmonary tuberculosis, and a definite diagnosis based on biomarkers is very challenging. Interleukin 32 (IL-32) is an inflammatory cytokine, crucial for the host immune response to tuberculosis. The purpose of this study is to determine the performance of IL-32 in the diagnosis of TPE. Materials and methods: This cross-sectional observational study was conducted in the Department of Respiratory Medicine of Bangladesh Medical University (BMU) among 50 participants aged 18-70 years who fit the inclusion and exclusion criteria. Pleural fluid was assessed for IL-32 and ADA via enzyme-linked immunosorbent assay to determine the diagnostic performance and compare them. Results: A total of 23 TPE and 27 non-TPE were identified by means of pleural biopsy findings, and in both instances males were predominant. Mean (±SD) age of TPE participants was 34.6 ± 17.3 years, and that of non-TPE was 57.32 ± 11.42 years. The most common symptoms were weight loss, anorexia, and fever in the TBE group. Mean pleural protein, lymphocyte, and ADA concentrations were significantly different between TPE and non-TPE (p-values <0.05, <0.001, and <0.001, respectively) but not for glucose and LDH (p-values 0.05 and 0.05). Also mean (±SD) pleural IL-32 levels were also significantly elevated in TPE (435.4 +360.3ng/L) compared to non-TPE (130.2 +80.0ng/L), (p value <0.001). An IL-32 cutoff of >240.8 pg/ml effectively diagnosed TPE with a sensitivity of 87.3, specificity of 94.3 and area under the curve (AUC) of 0.923. Conclusion: Interleukin-32 may play an important role in the diagnosis of TPE with its high diagnostic accuracy compared with adenosine deaminase. J MEDICINE 2026; 27(2): 72-77
Prader-Willi syndrome (PWS) is one of the most prevalent causes of syndromic obesity. This genetic disorder begins with hypotonia and poor feeding in the neonatal period, later evolving into hyperphagia and rapid weight gain during early childhood, frequently leading to severe obesity in adolescence and adulthood. We report a case of a 14-year-old boy presenting with morbid obesity (BMI: 47.4) and related complications. Before admission, he was not properly evaluated for obesity. Along with obesity, the presence of hypogonadism, undescended testes since childhood, learning difficulties, poor academic performance, and behavioral abnormalities, including temper tantrums and emotional outbursts, raised a strong suspicion of Prader–Willi syndrome (PWS). We used the consensus criteria for the diagnosis of PWS clinically and focused on managing obesity with a dual GIP/GLP-1 receptor agonist; the patient achieved a remarkable weight loss of 25 kg over one year and marked reversal of obesity–related complications, significantly improving the patient’s overall health and quality of life. J MEDICINE 2026; 27(2): 151-154
Background: Hepatitis C virus (HCV) infection is a major global health concern, often progressing to chronic liver disease, cirrhosis, and hepatocellular carcinoma if undiagnosed. Early and accurate diagnosis is critical for effective management. This study evaluated the diagnostic performance of the immunochromatographic test (ICT) and enzyme-linked immunosorbent assay (ELISA) in comparison to reverse transcription-polymerase chain reaction (RT-PCR) for HCV detection. Methods: A cross-sectional study was conducted among 50 participants, including 24 previously diagnosed HCV cases and 26 clinically suspected cases (History of HCV positive but no document and don’t take any treatment), at Chittagong Medical College and Chittagong Veterinary and Animal Science University between January 2019 and December 2019. Serum samples were tested for anti-HCV antibodies using ICT and ELISA. HCV RNA was detected using RT-PCR, considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated to assess the diagnostic performance of ICT and ELISA. Results: The study population had a mean age of 39.16 ± 13.66 years, with a male-to-female ratio of 1.27:1. ICT and ELISA detected anti-HCV in 60% and 52% of cases, respectively. RT-PCR confirmed HCV RNA in 48% of participants. Compared to RTPCR, both ICT and ELISA showed 91.67% sensitivity. ELISA demonstrated higher specificity (82.62%) than ICT (69.23%). PPV and NPV were 84.62% and 91.67% for ELISA, and 73.33% and 90% for ICT, respectively. Conclusion: Both ICT and ELISA are highly sensitive for anti-HCV detection; however, ELISA provides superior specificity and predictive accuracy. RT-PCR remains essential for confirming active HCV infection. Integrating serological screening with molecular confirmation ensures reliable diagnosis and better clinical management of HCV infection. J MEDICINE 2026; 27: 67-71
Introduction: Prostatic abscesses are uncommon urologic infections, often underdiagnosed due to their nonspecific symptoms and clinical overlap with acute bacterial prostatitis. Case: A 53-year-old diabetic man presented with constipation, abdominal pain, and urinary symptoms, and imaging revealed a large prostatic abscess compressing the rectum. Cultures grew Klebsiella pneumoniae, and treatment included intravenous antibiotics followed by transurethral unroofing of the abscess. Discussion: This case highlights the atypical presentation of prostatic abscess and underscores the importance of prompt imaging and intervention. J MEDICINE 2026; 27(2): 145-146
Background: Ethylene glycol poisoning is an uncommon yet potentially fatal toxicological emergency, resulting from adulterated alcohol consumption. Early recognition and rapid treatment are essential to prevent organ failure and mortality. Case Presentation: We report a 25-year-old tribal male who presented to Rajshahi Medical College Hospital with severe respiratory distress, abdominal pain, blurred vision, and altered consciousness following ingestion of a locally brewed alcohol (“Chuani”). Initial arterial blood gas (ABG) analysis revealed profound anion-gap metabolic acidosis (pH 6.93, HCO₃⁻ 6.93 mmol/L, base deficit 28.2 mmol/L). The patient was treated with fomepizole, intravenous sodium bicarbonate, and folic acid, along with other supportive measures. The initial suspicion was of a case of methanol poisoning. However, serum formate levels were negative; urine microscopy demonstrated calcium oxalate crystals, confirming ethylene glycol poisoning. Despite aggressive therapy, the patient developed refractory shock and respiratory failure and subsequently died. Conclusion: This case highlights the diagnostic challenges of adulterated alcohol poisoning in low-resource environments. Rapid metabolic evaluation, bedside urine microscopy, early antidote therapy, and community awareness regarding adulterated alcohol are crucial to reduce associated fatalities. J MEDICINE 2026; 27(2): 136-140
A 43-year-old man with disseminated tuberculosis and hepatitis B-related decompensated liver cirrhosis complicated by portal hypertension, esophageal varices, splenomegaly, and massive ascites was admitted with a seven-day history of progressive shortness of breath and sudden copious leakage of ascitic fluid following spontaneous rupture of an umbilical hernia. On examination, he was hypotensive (blood pressure- 90/60 mmHg), mildly anemic, moderately icteric, had clubbing with bilateral pedal oedema. Abdomen was non-tender and distended with tense ascites. A large non-tender, non-reducible umbilical hernia (figure 1) was present with overlying skin being blackish and necrosed, accompanied by continuous leakage of ascitic fluid (figure 2).We diagnosed the case as Flood syndrome, a rare complication of decompensated cirrhosis, characterized by spontaneous rupture of an umbilical hernia with external drainage of ascitic fluid. After hemodynamic stabilization, urgent surgical repair was done. Excision of umbilicus and anatomical repair was performed under subarachnoid block. His immediate postoperative condition improved; however, his clinical condition further deteriorated despite supportive management, and he died a few days after discharge. J MEDICINE 2026; 27(2): 158
Background: The occurrence of brain metastasis represents a critical event in the progression of malignant disease. Whole brain radiotherapy (WBRT) with 20 Gray administered in 5 fractions (short course) is a commonly employed treatment protocol for metastatic brain cancer. Given the limited survival associated with brain metastasis, a shorter WBRT regimen of 12 Gray in 2 fractions (ultra-short course) has been proposed as an alternative. Aim of the study: This study aimed to compare the efficacy, including response rates and toxicities, of ultra-short-course versus short-course whole-brain radiotherapy in patients with brain metastasis. Method: This quasi-experimental study included 118 patients who met the inclusion and exclusion criteria between January 2018 and June 2019. Participants were enrolled using convenience and purposive sampling and were allocated equally into two groups (n=59 each). Group A received ultra-short-course, and Group B received short-course WBRT. Follow-up assessments were conducted at one, two, four, and eight weeks after completion of radiotherapy. Each follow-up included clinical examination and relevant laboratory investigations. Data were compiled and analyzed using SPSS (Version 24.0) employing the chi-square test and Fisher’s exact test. Results: The most common symptoms associated with brain metastases were headache, nausea, vomiting, convulsions, and cognitive dysfunction. For Grade 3 headache, response rates were 76.19% in the ultra-short-course group and 75.00% in the short course group (p-value <0.05). For Grade 2 nausea, response rates were 54.55% in Arm A and 56.25% in Arm B (p-value <0.05). Therapeutic response rates for vomiting, convulsions, and cognitive dysfunction were similar between both groups. Fatigue, skin reactions, and alopecia were identified as common acute toxicities of whole brain radiotherapy, with comparable frequencies in both arms. These toxicities were manageable with appropriate supportive measures. Conclusion: Ultra-short-course whole brain radiotherapy demonstrates comparable effectiveness to short course radiotherapy for palliation of symptoms in metastatic brain cancer. This approach may facilitate treatment of a greater number of patients using existing resources, with manageable toxicities. J MEDICINE 2026; 27(2): 86-93
Background and aims: Drugs that have expired, unused, spilled, recalled, damaged, contaminated, or removed from circulation for other reasons are referred to as pharmaceutical waste. Pharmaceuticals and their waste pose a threat to human health and contribute significantly to environmental deterioration. Using a variety of sophisticated experimental approaches, numerous pharmaceutical compounds have been found in considerable amounts in groundwater, surface water, subsurface water, household waste water, municipal waste water, and industrial effluents. The current review focuses on pharmaceutical wastes’ effects on water quality, including their prevalence, characteristics, and environmental fate that endangers human health. Methods: Keywords including pharmaceutical wastes, pharmacological action of drug residue, drug waste in water, drug residue in environment, antibiotics in water, illicit drug substances, pharmaceutical waste disposal, wastewater treatment, and human health were used to search research databases including Google Scholar, EBSCO, PubMed, Springer, Science Direct, and NIH. The data was collected from the books, literatures and websites were then analyzed, discussed and properly summarized. Results: Pharmaceuticals, nanomaterials and cosmeceuticals are the products and their metabolite substances that are present in surface water, drinking water and wastewater are not well known in many cases. Even at low concentrations, many active pharmaceutical ingredients (APIs) maintain their biological activity, which might affect aquatic environments and have an impact on human health. So, public health is seriously at danger due to their unknown toxicity, teratogenicity, and carcinogenicity profile as well as a lack of monitoring and control mechanisms. Conclusion: To reduce environmental and human health risk, effective waste management, government policy, organization policy and public awareness are crucial to ensure that discarded pharmaceuticals wouldn’t contribute to exacerbate ecological problems and human health. J MEDICINE 2026; 27: 114-127
Background: Asthma is a common long-term lung disease, and university students are a key group for messages about how to prevent and manage it on their own. Methods: From April 2024 to August 2025, an online survey was conducted among 1,325 undergraduate and graduate students (538 male and 787 female) from 19 universities with a structured questionnaire consisting of 48 questions (15 about knowledge, 8 about attitude, and 10 about practice). Knowledge is rated from 0 to 15, with 0 being bad and 15 being good. 5-point Likert scales with set cut-offs are used to analyse attitude (8–40) and practice (10–50) scores. Welch's t-test/ANOVA or Mann–Whitney U are used to compare groups. Pearson correlation is used to examine relationships between KAP dimensions, and SEM is used to examine predictors (two-sided p<0.05). Results: The mean (±SD) scores are 12.02±3.41 for knowledge, 31.12±8.22 for attitude, and 43.12±8.95 for practice. Overall, 89.7% have good knowledge, 69.9% have a good attitude, and 88.0% have proactive practice towards asthma. There is a positive relationship between the KAP domains, with the strongest link between knowledge and practice (r=0.428, p<0.001). In analyses with more than one variable, being older is linked to having less knowledge, while being in a higher academic year and being interested in a free inhaler-technique workshop are linked to having more knowledge. Knowledge is also linked to both attitude and practice. Conclusion: Most Bangladeshi university students have a good understanding of asthma and how to deal with it. Skills-based campus programs, especially those that teach people how to use inhalers, may help fill in the gaps and improve asthma self-management. J MEDICINE 2026; 27(2): 102-113
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely related to obesity, type 2 diabetes mellitus, hypertension, and other cardiometabolic risk factors, with an increased risk of cardiovascular events, chronic kidney disease, hepatic and extrahepatic malignancies, and also liver-related outcomes, including liver failure. The nomenclature MASLD has a long evolution history from 1836 to 2023. The term Non Alcoholic Fatty Liver Disease (NAFLD) used previously did not include cardio-metabolic risk factors as diagnostic criteria. By contrast, MASLD should have at least one of the four defined cardiometabolic risk factors. Insulin resistance is nearly universal in patients with MASLD and is present in the liver, adipose tissue, and muscle. Adipose tissue insulin resistance is characterized by increased release of free fatty acids (FFA) from adipocytes (lipolysis) in the fasting state, which accumulate inside the liver and undergo triglyceride formation. Dietary carbohydrates, in the form of dietary sugars (e.g., fructose, sucrose, and glucose), drive the formation and accumulation of intrahepatic fat from de novo lipogenesis (DNL). This review discusses in depth the pathogenesis of hepatic steatosis and inflammation that may lead to hepatic cellular damage, fibrosis, and cirrhosis. The relationship of MASLD with type-2 diabetes mellitus, hypertension, obesity, and lipid abnormalities is also discussed in detail. In fact, MASLD should be viewed as a hepatic manifestation of metabolic syndrome. There are numerous mechanisms that may accelerate atherosclerosis and premature cardiovascular disease (CVD) in patients with MASLD. So MASLD should not be considered as an isolated disease; rather, it should be viewed as part of a spectrum of disease conditions. Its connectivity with other cardio-metabolic conditions highlights the importance of this dark horse of metabolic disorders. J MEDICINE 2026; 27(2): 128-135
Nine syndrome is a rare neurological condition characterized by ipsilateral conjugate horizontal gaze palsy (the "one"), ipsilateral internuclear ophthalmoplegia (INO) (the "half"), and ipsilateral lower motor neuron (LMN) facial cranial nerve palsy (the ‘’seven’’), which comprises ‘’Eight-and-a-half’’ in total. Here, the only possible horizontal movement is contralateral abduction. If ‘’Eight-and-a-half’’ is associated with contralateral hemiplegia, it is called ‘’Nine Syndrome’’. Common etiologies of this condition include vascular, demyelinating, and ICSOL. Here, we report the case of a 48-year-old diabetic man with no prior hospitalization who presented to the medicine department with the sudden onset of diplopia, vertigo, and facial asymmetry for 9 hours. On detailed neurological examination, he was found to have left-sided lower motor neuron facial palsy, impaired horizontal ocular movement involving the left eye, horizontal nystagmus on the abducting right eye, and right-sided extensor plantar response. The clinical constellation was consistent with Nine syndrome. An MRI performed later established an ischemic lesion in the left pons. Thrombolysis was not performed because the patient presented outside the recommended therapeutic time window. The patient showed early neurological improvement and was discharged with advice to have follow-up. J MEDICINE 2026; 27(2): 141-144
Carbohydrate antigen 19-9 (CA 19-9) is a recognized tumour marker for pancreatic and biliary tract malignancies. Markedly elevated CA 19-9 in gastric carcinoma may lead to diagnostic ambiguity. This case illustrates an unusually raised CA 19-9 in the context of gastric cancer. Here, our patient, a 70-year-old woman, came for evaluation of anorexia, fatigue, significant weight loss, abdominal pain, and constipation for three months. She had anaemia and hepatomegaly. Her haemoglobin level and serum albumin were reduced (8.6 g/dl and 28 g/L respectively). Tumour markers assay revealed significant elevation (10800 U/ml) of CA 19-9 level (normal: <37 U/ml). Contrast-enhanced computed tomography (CECT) of the whole abdomen showed infiltrative growth at the lower part of the body and pyloric part of the stomach with proximal distension, abdominal lymphadenopathy, multiple hepatic metastases, and normal pancreatic or biliary tract. Upper gastrointestinal (UGI) endoscopy revealed an ulcero-proliferative lesion in the antrum involving the lower body and pylorus leading to partial gastric outlet obstruction. Subsequently, gastric tissue biopsy confirmed papillary adenocarcinoma, grade II. At this stage, the patient’s family refused further oncological management. One and a half months later, we came to know that the patient eventually passed away. From this case scenario, it can be concluded that though markedly raised CA 19-9 alone is not diagnostic for gastric cancer, yet can be correlated with tumour burden and disease progression in the context of confirmed gastric malignancy with metastases. J MEDICINE 2026; 27(2): 155-157
Background: Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis, is a rare genetic disorder characterized by the triad of digital clubbing, periostosis of long bones, and pachydermia. It accounts for only 3–5% of all hypertrophic osteoarthropathy cases. Case Presentation: We report the case of a 22-year-old male who presented with progressive clubbing of the fingers and toes, periosteal new bone formation causing painless bony swelling of multiple joints, and coarsening of facial skin (pachydermia) over two years. There was no evidence of underlying cardiac, pulmonary, or gastrointestinal disease. Imaging revealed diffuse periosteal thickening of the distal long bones. After exclusion of secondary causes, a diagnosis of primary hypertrophic osteoarthropathy was established. Conclusion: This case highlights the importance of recognizing PHO in young patients with clubbing and periostosis to differentiate it from secondary causes and avoid unnecessary investigations. J MEDICINE 2026; 27(2): 147-150
Background: Early identification of patients requiring mechanical ventilation (MV), either invasive or non-invasive, is critical to reduce morbidity and mortality in community-acquired pneumonia (CAP). Cortisol,a primary stress hormone, may serve as a prognostic marker in CAP. Objective: To evaluate the association between admission serum cortisol levels and the need for MV in patients with CAP. Methods: This prospective study enrolled 92 adults with CAP admitted to Dhaka Medical College Hospital over 12 months. Serum cortisol was measured at 9:00 AM on the first available morning after admission using ELISA.All participants were categorized into high cortisol (>23 mcg/dL) and normal cortisol (< 23 mcg/dL) groups. The primary outcome was the requirement for MV. Logistic regression and receiver operating characteristic (ROC) analysis were applied to assess predictive value. Results: Patients with high cortisol had a significantly greater need for MV compared with those with normal levels (31.8% vs 4.2%, p = 0.001). High cortisol independently predicted MV (OR = 10.7, 95% CI: 2.28–50.6, p = 0.030). ROC analysis showed good discriminative ability for cortisol (AUC = 0.831), while CURB-65 (AUC = 0.972) and CRP (AUC = 0.947) performed better. Conclusion: Admission serum cortisol is independently associated with the need for MV in CAP patients and provides additional prognostic information beyond conventional severity scores. Incorporating cortisol measurement into early assessment may improve risk stratification and help guide timely escalation of care, especially in resource-limited settings.
Extrapulmonary tuberculosis (EPTB) represents a major but under-recognized element of the tuberculosis (TB) burden in Bangladesh. Although pulmonary TB (PTB) remains the dominant form of the disease, EPTB accounts for a notable proportion of national TB cases, ranging from 15–30% based on hospital and community-level studies. EPTB manifests in variegated anatomical sites—including lymph nodes, pleura, abdomen, bones, urogenital tract, and the central nervous system—often presenting with nonspecific symptoms that overlap with malignancy, autoimmune disorders, or bacterial infections.These diagnostic challenges combined with the paucibacillary nature of EPTB, complicate clinical evaluation and contribute to delays in management. Recent improvements in molecular diagnostics such as Gene Xpert MTB/RIF have enhanced case detection; however, access remains uneven across Bangladesh, especially in rural and district-level facilities.This review synthesizes the current evidence on extrapulmonary tuberculosis (EPTB) in Bangladesh, covering epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, treatment, and systemic challenges. It highlights local research published in BanglaJOL, National TB Program (NTP) data, tertiary hospital studies, and WHO guidance adapted to the Bangladeshi context.Although less common than pulmonary MDR-TB, drug-resistant EPTB presents significant clinical and public health challenges. Reducing EPTBrelated morbidity and long-term complications requires multisectoral strategies, which includes enhanced laboratory capacity, standardized diagnostic protocols, decentralized molecular testing, and targeted clinician training. This review seeks to assist clinicians, researchers, and policymakers by consolidating current knowledge and identifying key gaps and priorities for future action. J MEDICINE 2026; 27(1): 40-48
Takayasu’s arteritis is a rare, chronic form of large- and medium-vessel vasculitis, predominantly affecting the aorta and its primary branches. Histopathologically, it is characterized by mononuclear cell infiltration and granulomatous inflammation of the vascular media, resulting in progressive arterial wall thickening, stenosis, occlusion, or aneurysmal dilation. Involvement of the common carotid arteries is a notable but atypical manifestation, often contributing to diagnostic complexity. The disease can lead to serious complications, including stroke, ischemic heart disease, pulmonary hypertension, secondary systemic hypertension, and aneurysm formation. Diagnosis is primarily based on a combination of clinical presentation and angiographic findings. J MEDICINE 2026; 27(1): 55-57
